Quitting one’s job or leaving one’s profession: unexplored consequences of workplace violence and discrimination against health professionals

Background Although workplace violence and discrimination against healthcare workers are global and universal phenomena, and violence at work is recognized as a serious and growing problem, in Switzerland, hardly anything is known about the related consequences on job changes and career endings, which are two major staffing challenges present in the notoriously understaffed healthcare sector. Method Data collected from a written survey conducted among 1,840 hospital employees, of which 1,441 were health professionals, were used to evaluate and estimate the prevalence and impact of specific and cumulated forms of workplace violence and discrimination on the work climate and particularly on subsequent turnover intentions and career endings. Established multi- and single-item measures were used as predicting, intervening and outcome variables. Relative frequencies stratified for nurses, physicians and therapists were calculated to estimate and differentiate the size of the phenomena under study. Furthermore, crosstabulations, as well as multivariate regression analyses, were performed to explore the associations of interest. Results Every fifth to sixth nurse and every seventh to eighth physician reported having had intentions to change jobs or leave the profession within the past year. These intentions become much more prevalent across all health professions when one or even two or more different forms of violence and/or discrimination at work are experienced and reported. Accordingly, the relative risks for intending to quit one’s job or leave one’s profession increase significantly and steadily with a growing number (1, 2 +) of different experienced forms of violence and/or discrimination at work compared to the reference group of those who are nonaffected (aOR from 2.5 up to 5.4). This fairly strong association was only slightly reduced (aOR from 2.1 to 4.0) when work climate was additionally taken into account as a potential intervening variable. Although work climate only partly accounted for the association under study, a poor work climate was an additional strong predictor and independent risk factor for intentions to turnover (aOR = 6.4) or leave the profession (aOR = 4.2). Conclusions Experiences of workplace violence and discrimination and the resulting poor work climate both together and independent of each other seem to be important causes of job changes and career endings among healthcare workers in Switzerland

Over-indebtedness, mastery and mental health: a cross-sectional study among over-indebted adults in Switzerland

Objectives: The aim is to investigate whether and why over-indebted individuals in German-speaking Switzerland have poorer mental health than the general population. Methods: A cross-sectional study among over-indebted people in the canton of Zurich was conducted in 2019. The study population (n = 219) was compared to the cantonal subsample of the general adult population selected from the nationally representative sample of the Swiss Health Survey 2017 (n = 1,997). Bivariate and multivariate statistical analyses were used to examine associations between over-indebtedness, mastery and health outcomes like mental stress and depression. Results: Over-indebted people have poorer mental health and weaker mastery than the general population. Low mastery is the strongest predictor of poor mental health (beta coefficient = 0.58/-0.62 for mental stress/depression respectively) among the over-indebted, followed by the perception of one's health being affected by over-indebtedness (beta coefficient = -0.19/0.15). The amount of debt, anticipated time until repayment of debt and duration of indebtedness had no predictive effects. Conclusion: Surprisingly, traditional debt parameters cannot explain the poor mental health of the over-indebted, in contrast to a strong sense of mastery, which was identified as a highly protective factor

Over-indebtedness and health in Switzerland: A cross-sectional study comparing over-indebted individuals and the general population

Background Previous international studies have shown that over-indebtedness is associated with poor health. However, in Switzerland research addressing over-indebtedness is widely lacking, strongly needed and particularly important because it is evidently a rising but still commonly tabooed, socially “undesired” and highly stigmatized phenomenon that is rarely discussed and largely ignored and unexplored. Methods A cross-sectional survey was conducted among over-indebted adults seeking advice from one of the four official debt advisory centers in the Canton of Zurich. The survey finally included 219 respondents participating voluntarily and anonymously. This sample was then linked with a comparable subsample of the nationally representative Swiss Health Survey of 2017, namely 1,997 respondents of the same age from the Canton of Zurich. For reasons of comparability identical health questions and measures were taken from the Swiss Health Survey and used in the over-indebtedness survey. The pooled or combined dataset covered a total of 2,216 adult individuals. Results Remarkably high prevalence rates and relative risks of poor self-rated health, severe musculoskeletal and sleep disorders and moderate to severe depression were observed among over-indebted individuals compared to the general population. More than 50% of the over-indebted individuals had poor general health or moderate to severe depression compared to the general population with 14% and 7%, respectively. And far above one third of the over-indebted but ‘only’ between 6% and 8% of the general population showed severe musculoskeletal disorders and sleep disorders. Even after adjustment for various control variables and covariates, over-indebtedness increased the odds ratios for poor health outcomes consistently and dramatically, i.e. by a factor of 8 and more (aOR = 8.5–11.6). Conclusions Over-indebtedness in Switzerland has particularly negative effects on various aspects of the health of the persons concerned, irrespective of their demographic characteristics and their social and employment status

Work-life imbalance and mental health among male and female employees in Switzerland

Objectives: To investigate the prevalence and mental health effects of an unequal work-life balance (WLB) including potential gender differences. Methods: A cross-sectional study based on a representative sample of the Swiss employed population aged 20 to 64 (women: n = 1661; men: n = 1591). Results: Based on a single-item measure, more than every seventh employee in Switzerland indicated major difficulties combining work and private life. In certain socio-demographic categories, up to 30% showed such work-life conflict (WLC). For both genders, work-life imbalance turned out to be a risk factor affecting mental health. Employees with self-reported WLC presented a significantly higher relative risk for poor self-rated health (women: aOR = 2.6/men: aOR = 2.0), negative emotions and depression (aOR = 3.0/3.1), low energy and optimism (aOR = 2.1/1.6), fatigue (aOR = 2.4/2.6), and sleep disorders (aOR = 1.8/1.5) compared to employees with no WLC. Conclusions: Internationally, few data on the prevalence of WLC exist. In Switzerland, work-life imbalance is not a marginal phenomenon among the workforce and needs to be addressed as a notable public and mental health issu

Prevalence and health correlates of workplace violence and discrimination against hospital employees - a cross-sectional study in German-speaking Switzerland

Background: Violence and discrimination are common events at work, especially in health care. Moreover, such workplace experiences are considered to have negative impacts and particularly adverse health consequences on health care workers. Nevertheless, the problem is still highly underreported and thus largely ignored and unexplored in Switzerland as comprehensive data and studies on their prevalence and health correlates among hospital staffs and health professionals are widely missing. Methods: This cross-sectional study was based on secondary data from a company survey among several public hospitals and rehabilitation clinics in German-speaking Switzerland conducted in 2015/16. The study population was limited to a subsample of 1567 health professionals among the surveyed staffs of five participating hospitals and clinics. Relative frequencies of different forms of violence and discrimination at work and the total number of such experiences were calculated for the entire study population and for occupational subgroups. These data were compared with a nationally representative subsample of the Swiss Health Survey 2017 as a reference population. Multiple logistic regression analyses were further computed to investigate the association between the number of different experienced forms of violence and/or discrimination at work and several poor general and mental health outcomes. Results: 23% of the inverviewed hospital employees experienced at least one form of discrimination or violence at work in the past year, compared to 18% of the general working population. Nurses were by far the most affected occupational group regarding all forms of violence. More and particularly the most exposed and affected hospital employees with regard to experiences of violence and/or discrimination at work showed almost consistently increased frequencies and relative risks for the studied poor mental and general health outcomes. Prevalence rates and odds ratios for strong sleep disorders, strong stress feelings and increased burnout symptoms were between 3 and 4 times higher among the most exposed compared to the non-exposed group of hospital employees. Conclusions: Study findings underline the importance of an active combat against violent and discriminatory behaviors in health care. Prevention strategies should particularly focus on nurses and midwives, which turned out to be the most affected and exposed group of all health professions. Keywords: General health; Hospital employees; Mental health; Workplace discrimination; Workplace violence

Socioeconomic status, working conditions and self-rated health in Switzerland: explaining the gradient in men and women

Objectives:: Epidemiological research has confirmed the association between socioeconomic status (SES) and health, but only a few studies considered working conditions in this relationship. This study examined the contribution of physical and psychosocial working conditions in explaining the social gradient in self-rated health. Methods:: A representative sample of 10 101 employees, 5003 women and 5098 men, from the Swiss national health survey 2002 was used. SES was assessed according to the EGP-scheme. Working conditions included exposure to physical disturbances, physical strain, job insecurity, monotonous work and handling simultaneous tasks. For data analysis logistic regression analyses were performed. Results:: Data show a social gradient for self-rated health (SRH) as well as for physical and psychosocial working conditions. Logistic regression analysis controlling for age, gender and level of employment showed both physical and psychosocial working conditions to be significant predictors of SRH. Physical and psychosocial working conditions such as physical disturbances from work environment, physical strains in doing the job, monotony at work, job insecurity etc. could explain most of the social gradient of SRH in men and women. Conclusion:: The study confirmed the relevance of modifiable physical and psychosocial working conditions for reducing social inequality in health. Gender differences need to be considered in epidemiological and intervention studie

Social determinants of duration of last nursing home stay at the end of life in Switzerland: a retrospective cohort study

BACKGROUND Due to demographic ageing and increasing life expectancy, a growing demand for long-term nursing home care can be expected. Stays in nursing homes appear to be more socially determined than hospital stays. We therefore looked at the impact of socio-demographic and health care variables on the length of the last nursing home stay. METHODS Nationwide individual data from nursing homes and hospitals in Switzerland were linked with census and mortality records. Gender-specific negative binomial regression models were used to analyze N = 35,739 individuals with an admission age of at least 65 years and deceased in 2007 or 2008 in a nursing home. RESULTS Preceding death, men spent on average 790 days and women 1250 days in the respective nursing home. Adjusted for preceding hospitalizations, care level, cause of death and multimorbidity, a low educational level, living alone or being tenant as well as a low care level at the admission time increased the risk for longer terminal stays. Conversely, a high educational level, being homeowner, being married as well as a high care level at the admission time decreased the risk for longer stays. DISCUSSION The length of the last nursing home stay before death was not only dependent on health-related factors alone, but also substantially depended on socio-demographic determinants such as educational level, homeownership or marital status. The support of elderly people at the admission time of a presumably following nursing home stay should be improved and better evaluated in order to reduce unnecessary and undesired long terminal nursing home stays. CONCLUSIONS Health policy should aim at diminishing the role of situational, non-health-related factors in order to empower people to spend the last years before death according to individual needs and preferences

Development of life satisfaction in young physicians: results of the prospective SwissMedCareer Study

Purpose: The objectives of the study were to investigate the gender-related development of life satisfaction in young physicians over an 8-year period of residency, to compare it with a representative sample, and to analyze the relationships between both person- and health-related factors and life satisfaction. Methods: A prospective study was carried out including five measurement points among a cohort of 337 Swiss physicians. Measurements include domain-specific life satisfaction (FLZM), sense of coherence (SOC-13), anxiety and depression (HADS-D), chronic stress (TICS) and socio-demographic variables. Data were analyzed with multivariate procedures. Results: Life satisfaction in physicians of both genders is lower compared to a representative sample. Over the 8-year period of residency, the course of life satisfaction seems to be rather unstable and domain-specific. Female physicians are more satisfied with life than their male counterparts. Depressive symptoms and stress experience are highly negatively associated with life satisfaction in multivariate analysis. Conclusions: To study the development of life satisfaction over time, it is more appropriate to use a domain-specific life satisfaction questionnaire than a total score. Furthermore, it is a matter of concern that—compared to a representative sample—physicians in residency show lower life satisfaction at all measurement points. Depressive symptoms and chronic stress are found to diminish life satisfaction. This could keep some physicians from staying in the medical profession. Senior physicians should be aware of the negative impact of chronic stress on life satisfactio

Persistent work-life conflict and health satisfaction - A representative longitudinal study in Switzerland

Background: The objectives of the present study were (1) to track work-life conflict in Switzerland during the years 2002 to 2008 and (2) to analyse the relationship between work-life conflict and health satisfaction, examining whether long-term work-life conflict leads to poor health satisfaction. Methods: The study is based on a representative longitudinal database (Swiss Household Panel), covering a six-year period containing seven waves of data collection. The sample includes 1261 persons, with 636 men and 625 women. Data was analysed by multi-level mixed models and analysis of variance with repeated measures. Results: In the overall sample, there was no linear increase or decrease of work-life conflict detected, in either its time-based or strain-based form. People with higher education were more often found to have a strong work-life conflict (time- and strain-based), and more men demonstrated a strong time-based work-life conflict than women (12.2% vs. 5%). A negative relationship between work-life conflict and health satisfaction over time was found. People reporting strong work-life conflict at every wave reported lower health satisfaction than people with consistently weak work-life conflict. However, the health satisfaction of those with a continuously strong work-life conflict did not decrease during the study period. Conclusions: Both time-based and strain-based work-life conflict are strongly correlated to health satisfaction. However, no evidence was found for a persistent work-life conflict leading to poor health satisfaction

Work-life conflict and musculoskeletal disorders: a cross-sectional study of an unexplored association

BACKGROUND: The health consequences of work-family or rather work-life conflict (WLC) have been studied by numerous researchers. The work-related causes of musculoskeletal disorders (MSD) are also well explored. And stress (at work) has been found to be a consequence of WLC as well as a cause of MSD. But very little is known about a potential association between WLC and MSD and the possible mediating role of stress in this relationship. METHODS: Survey data collected in 2007 among the workforces of four large companies in Switzerland were used for this study. The study population covered 6091 employees. As the exposure variable and hypothesized risk factor for MSD, WLC was measured by using a 10-item scale based on an established 18-item scale on work-family conflict. The outcome variables used as indicators of MSD were (low) back pain and neck/shoulder pain. Stress as the assumed intervening variable was assessed by a validated single-item measure of general stress perception. Correlation coefficients (r), standardized regression coefficients (beta) and multiple adjusted odds ratios (OR) were calculated as measures of association. RESULTS: WLC was found to be quite strongly associated with MSD (beta=.21). This association turned out to be substantially confounded by physical strain at work, workload and job autonomy and was considerably reduced but far from being completely eliminated after adjusting for general stress as another identified risk factor of MSD and a proven strong correlate of WLC (r=.44). A significant and relevant association still remained (beta=.10) after having controlled for all considered covariates. This association could be fully attributed to only one direction of WLC, namely the work-to-life conflict. In subsequent analyses, a clear gradient between this WLC direction and both types of MSD was found, and proved to be consistent for both men and women. Employees who were most exposed to such work-to-life conflict were also most at risk and showed a fivefold higher prevalence rate (19%-42%) and also an up to sixfold increased relative risk (OR=3.8-6.3) of suffering greatly from these types of MSD compared with the least exposed reference group showing very low WLC in this direction. Including stress in the regression models again reduced the strength of the association significantly (OR=1.9-4.1), giving an indication for a possible indirect effect of WLC on MSD mediated by stress. CONCLUSION: Future research and workplace interventions for the prevention of MSD need to consider WLC as an important stressor, and the MSD risk factor identified in this study