Organisational justice and health of employees: prospective cohort study

Aims: To examine the association between components of organisational justice (that is, justice of decision making procedures and interpersonal treatment) and health of employees.Methods: The Poisson regression analyses of recorded all-cause sickness absences with medical certificate and the logistic regression analyses of minor psychiatric morbidity, as assessed by the General Health Questionnaire, and poor self rated health status were based on a cohort of 416 male and 3357 female employees working during 1998-2000 in 10 hospitals in Finland.Results: Low versus high justice of decision making procedures was associated with a 41% higher risk of sickness absence in men (rate ratio (RR) 1.4, 95% confidence interval (CI) 1.1 to 1.8), and a 12% higher risk in women (RR 1.1, 95% CI 1.0 to 1.2) after adjustment for baseline characteristics., The corresponding odds ratios (OR) for minor psychiatric morbidity were 1.6 (95% CI 1.0 to 2.6) in men and 1.4 (95% CI 1.2 to 1.7) in women, and for self rated health 1.4 in both sexes. In interpersonal treatment, low justice increased the risk of sickness absence (RR 1.3 (95% CI 1.0 to 1.6) and RR 1.2 (95% CI 1.2 to 1.3) in men and women respectively), and minor psychiatric morbidity (OR 1.2 in both sexes). These figures largely Persisted after control for other risk factors (for example, job control, workload, social support, and hostility) and they were replicated in initially healthy subcohorts. No evidence was found to support the hypothesis that organisational justice would represent a consequence of health (reversed causality).Conclusions: This is the first longitudinal study to show that the extent to which people are treated with justice in workplaces independently predicts their health

Employee control over working times: associations with subjective health and sickness absences

Study objective: To investigate the impact of employees' worktime control on health, taking into account other aspects of job control. Design: Analysis of questionnaire data in 1997 and register data on sickness absence during 1996–1998. Setting: Eight towns in Finland. Participants: 6442 municipal employees (1490 men and 4952 women) representing the staff of the towns studied. Follow up was 17 706 person years. Main results: In women, poor health and psychological distress were more prevalent among those in the lowest quartile of worktime control than those in the highest (after adjustment for potential confounders including other aspects of job control, odds ratios and their 95% confidence intervals for poor health and psychological distress were 1.8 (1.5 to 2.3) and 1.6 (1.3 to 2.0), respectively). Correspondingly, the adjusted sickness absence rate was 1.2 (1.1 to 1.2) times higher in women with low worktime control than in women with high worktime control. In men, no significant associations between worktime control and health were found. These results, obtained from the total sample, were replicable within a homogeneous occupational group comprising women and men. Conclusions: Exploration of specific aspects of job control provides new information about potentially reversible causes of health problems in a working population. Worktime control is an independent predictor of health in women but not in men. Dissimilarities in the distribution of occupations between men and women are not a probable explanation for this difference

Sickness absence as a global measure of health: evidence from mortality in the Whitehall II prospective cohort study

Objective: To examine the association between sickness absence and mortality compared with associations between established health indicators and mortality. Design: Prospective cohort study. Medical examination and questionnaire survey conducted in 1985-8; sickness absence records covered the period 1985-98. Setting: 20 civil service departments in London. Participants: 6895 male and 3413 female civil servants aged 35-55 years. Main outcome measure: All cause mortality until the end of 1999. Results: After adjustment for age and grade, men and women who had more than five medically certified absences (spells greater than 7 days) per 10 years had a mortality 4.8 (95% confidence interval 3.3 to 6.9) and 2.7 (1.5 to 4.9) times greater than those with no such absence. Poor self rated health, presence of longstanding illness, and a measure of common clinical conditions comprising diabetes, diagnosed heart disease, abnormalities on electrocardiogram, hypertension, and respiratory illness were all associated with mortality-relative rates between 1.3 and 1.9. In a multivariate model including all the above health indicators and additional health risk factors, medically certified sickness absence remained a significant predictor of mortality. No linear association existed between self certified absence (spells 1-7 days) and mortality, but the findings suggest that a small amount of self certified absence is protective. Conclusion: Evidence linking sickness absence to mortality indicates that routinely collected sickness absence data could be used as a global measure of health differentials between employees. However, such approaches should focus on medically certified (or long term) absences rather than self certified absences

Depressive symptoms and obesity: instrumental variable analysis using mother–offspring pairs in the 1970 British Cohort Study

Background: The extent to which depression and obesity are causally related remains to be determined. We used intergenerational data on mother–offspring pairs in an instrumental variable analysis to examine the longitudinal association between adolescent depressive symptoms and body mass index (BMI) in adulthood. Methods: A total of 4733 mother–offspring pairs were identified from the 1970 British Cohort Study. Mothers completed the Malaise Inventory to assess depressive symptoms on three occasions across their offsprings' childhood/adolescence (aged 5, 10 and 16 years). Height and weight were recorded in mother and offspring (aged 16 years). Measures of height, weight and the Malaise Inventory were repeated in the participant at the age of 42 years. Results: Maternal malaise score was associated with offspring malaise score, thus confirming the validity of the chosen instrumental variable. A higher mother’s malaise score was associated with higher offspring BMI at follow-up (B=0.043; 95% confidence interval (CI): 0.013, 0.072). There was a higher risk of adulthood offspring obesity in mothers with two or three episodes of depression compared with one or none (odds ratio, 1.42; 95% CI: 1.14, 1.76). The maternal malaise–offspring BMI association remained (P=0.003) after adjustment for offspring malaise score, suggesting that maternal mental health influences offspring obesity through mechanisms other than depression. Results from standard and instrumental variable analyses did not support a causal pathway in a direction from BMI to depression. Conclusions: Our data support a causal pathway linking adolescent depressive symptoms to adiposity in adulthood over 26 years follow-up. The reverse direction, that is, adiposity to depression, was not supported

Organisational downsizing, sickness absence, and mortality: 10-town prospective cohort study

Objective To examine whether downsizing, the reduction of personnel in organisations, is a predictor of increased sickness absence and mortality among employees.Design Prospective cohort study over 7.5 years of employees grouped into categories on the basis of reductions of personnel in their occupation and workplace: no downsizing ( 18%).Setting Four towns in Finland.Participants 5909 male and 16 521 female municipal employees, aged 19-62 years, who kept their jobs.Main outcome measures Annual sickness absence rate based on employers' records before and after downsizing by employment contract; all cause and cause specific mortality obtained from the national mortality register.Results Major downsizing was associated with an increase in sickness absence (P for trend < 0.001) in permanent employees but not in temporary employees. The extent of downsizing was also associated with cardiovascular deaths (P for trend < 0.01) but not with deaths from other causes. Cardiovascular mortality was 2.0 (95% confidence interval 1.0 to 3.9) times higher after major downsizing than after no downsizing. Splitting the follow up period into two halves showed a 5.1 (1.4 to 19.3) times increase in cardiovascular mortality for major downsizing during the first four years after downsizing. The corresponding hazard ratio was 1.4 (0.6 to 3.1) during the second half of follow up.Conclusion Organisational downsizing may increase sickness absence and the risk of death from cardiovascular disease in employees who keep their jobs